Ahmedabad, 11 September 2013

Rishi Khatau who will turn five years next month end has become the youngest child in the world to undergo bariatric surgery to lose weight, claimed surgeons of Asian Bariatrics here on Wednesday. The Team of Doctors headed by Dr. Narwaria said that Rishi, a four year and ten months old Kutchi Gujarati boy, was morbidly obese weighing 44.5 kg and suffered severe difficulty in breathing while sleeping wherein his oxygen saturation levels dropped below 60 per cent leaving him gasping for breath.

Ironically, Rishi was born underweight at 1.8 kg in 2008. His weight was normal till he was one and half years. After which it started increasing abnormally. Rishi was diagnosed to be suffering from ‘Prader Willi Syndrome’, a rare genetic disorder caused by deletion or disruption of genes. That Rishi consumed 1500 calories per day only added fuel to fire his obesity. While Rishi’s obesity had slowed him down, it also posed him a grave health danger.

Rishi’s father Dipen, a businessman in Kolkata, said that his sleep disorder had become so acute that his little boy could not sleep lying down for over ten minutes—he would wake up gasping for breath! Sleep Study performed on him by Dr. Ajay Shah(Pulmonologist) was indicating Severe Sleep Apnoea .The situation turned serious as no medication worked and the family opted for surgery.

“Sleep apnea in acute form can also prove fatal. Generally, we would avoid bariatric surgery in such a young child but his problem was acute & serious. It was a challenge operating on such a young patient but fortunately Rishi has recovered fine and will be discharged soon”, said Dr. Mahendra Narwaria, leading Bariatric Surgeon of Ahmedabad-based Asian Bariatrics Hospital.

Dr. Narwaria said that Rishi’s sleep apnea was direct fallout of his obesity. “In obese children, the intra abdominal pressure becomes very high, there is not enough space for the lungs to expand to full capacity. This leads to less oxygen in the body. The disturbed exchange of gases also leads to water retention and hence more weight gain”, said Dr Narwaria.

Surgeons said that it was challenging to operate on Rishi due to his age. “We had to use specific sleeve sizer and smaller stapler to perform the surgery to reduce the size of his stomach to one third. Since he is a growing child, we have not bypassed any portion of his intestine so that he does not suffer any malnutrition”, said Dr Narwaria.

“Currently, Rishi is being accustomed to use non-invasive ventilator (BiPEP) to maintain his oxygen levels. With his calorie intake reduced to 400 calories, Rishi is expected to lose weight and reach within the normal limits within a year and half. He is also advised swimming, playing and other physical activity to aid his slimming. Bariatric Surgery in patients of Prader Willi Syndrome is advised and we know that result are slow in such situation still we had to opt for this drastic decision due to serious nature of his obesity” said Dr. Sanjay Patolia.

Dr. Manish Khaitan, said, “We had many challenges to manage such a young boy both during operation & post –opreratively, but our experienced team of doctors and staff could do it very well. Such high risk cases can be operated only at such high volume centers who are well equipped and well trained in such conditions.”

The other doctors in the team who helped managing this case were Dr.Nidhish Nanavati(Pediatrician), Dr.Ajay Shah (Pulmonologist), Dr.Vivek Arya (Endocrinologist), Dr.Yogesh Tank & Dr. Parag Gohil (Anesthesiologist) and Ms. Devanshi Choksi (Nutritionist).